17881 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
WIL"DING APPLICATION & PERMIT
A°DaEaa ^ � ¢ 17881
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
Nps ilp OTV. ELECTRIC PERMIT FEE
`` / PHONE
NAMEaAc*oHs UTLETS-SWITCHES-RECEP 10.00/1.00
uc.No7 p ��dLIGHTING FIXTURES 10.00/1.00
CONTRACTOR
's - PPLIANCES-RESIDENTIAL 4.00
ADDRESS
/ESAC
y HONE 9-/.7 fir PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
on PANELS (OVER 200 AMP) 20.00 ,
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00 ��
ADDRESS rS MOTORS SEE FEE SCH. O 1
ADDRESS
SERVICE CHANGE PAID 20.00 /�F �Tn li v&( /
S' 0 LICENSED CONTRACTORS DECLARATION (-`- I`�yl l
er U w I hereby afflrin that I nm licensed under provisions of Chapter 9 ISSUANCE DATE
81
a a (commencing with Section 7000)of Division 3 of the gyyBBII��ine}j}js and BLDG. ELECT. PLG. MECH.
H z Professions Co and ny license is in full fo� ❑ ❑ ❑
zoo;{^ Licen ss Lic.Numher p y�I rip
-HO y I- Dut Contrncmr sky.Qf IIpB IIID
a se BUILDING PERMIT
¢ a OW fiR-BUILDER DIiCLARAT'ION INFORMATION
MISC.- REFER TO ORD
X ; w I hereby effinn that I am exempt from the Contractor's License VALUATION $/FT.
LLOa Law for the ity or countywhih e.703 requiresa peiodt sand Professions PERMIT ISSUANCE 10.00 OD
so improve,Code:Any city or county which reyuiresa permit lnconslrucLalter, ELEC. LIC.NO. v -
i
¢ ¢ a O requires,demolish,or repair any structure,prior to its issuance,also ELEC.
iD¢ requires the applicant for such permit to file a signed statement that TOTAL PpRMIT TO
E
m" he is licensed pursuant to the provisions of the Contractor's License L I,vD
r t a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ,` Rl \�
4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
ke p4
¢ I- mthe basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
dq- by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
Intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.ET.FLOOH AREA TOTAL ACREAGE
himself re through his own employees,provided however,
such im building
memsam not hroug his or offered eeor sale.lf,ed that suhebuilding GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
ti builder will have the burden of proving that he did not build or im-
_ prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON Pe Other
❑ I,as owner of the property,am exclusively contracting with . .
❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec, 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractods)licensed pursuant to SEWER-SANITARY-STORM EA.200tt/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0,
WORKIiRS'COM PENSA'I'ION UECLA RA'p10N WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a'certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lah.0.).
Policy No. Company
Q Cerlilied Copy is hurt hy furnished.
FIRE SPR INK ENERGY T-24
Z Z Cert ifi Y vilh tlI it ins 'vision. Y ❑ N❑ Y ❑ N❑
O p�ph,5cant �i MISC.- REFER TO ORD.
to ///rel T Ife+lao(.�'li@k4 PROM :[UOI S` PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
W M NSATION INSURANCE PLG,CONTR. LIC.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
Zoom red dollars IS 100)or less.)
U O 1 certify thutin the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL l- mit is issued.I shall not employ any person in any manner so as to
U w become subject to the Workers'Compensation Laws of California. ab
y Dune ApplicantALTER OR ADD TO MECH. 5.00 BUILDING J
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex
? enption,you should become subject to the Workeri Compensation APPLIANCE 5,00 PLAN CHECK
provisions of the Labor Code, you must forthwith roundly with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE f
I hereby ultimo that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATING UNIT(OVER 100,000 B.T.U.19,50
Lender's Adduces ELECTRIC
I certify that I have read this application and state that the shove VENTILATION FAN (SINGLE) 4.00
information n correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating IG building construction, and BOILER-COMP(3 H.P.Dr 100,000 B.T.U.) 6.00 '
t hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purpo
L,al�r%
) agree to save, indemnify and kee w less the City of MISC.- REFER TO ORD.
no against Iia 'li •s,jud meats, sts ul cxpe sec ich PERMIT ISSUANCE 10.00 CONST.TAX
anywayace arconthe of tl' pe MECH.CONT. LIC.NO, MECH.
TOTAL TOTAL
Signet o pp enl/Cn or ole
_ , OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
" PERMIT NUMBER
4
CITY OF CUPERTINO 17881
'INSPECTION DIVISION '
E c JOB INSPECTION /RECORD
�/7 T� C�� r(^ PERMIT EXPIRATION
JOB ADDRESS UNIT# _LOT# - PERMIT EXPIRES IF WORK
C.
OWNER UL(.V' CONTRACTOR L CO Q1 IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR LINSPE TION ECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE:
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE CUPERTINO STANDARDS. C
GARAGE SLABS PAID
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB MAY 10 5 lqsg A x 1E,;iq ,•,( �
PLUMBING
V�
ELECTRICAL City of Ciipprtona IssuANr uAT
MECHANICAL HUIc EECT R
't I
LPLG. MCC
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION
'Qr $/FT.
MECHANICAL
ELECTRICAL P NUT TO
FRAMING
INSULATION STOCRES TYPE TNSTR
OCC.CROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
-
ROOF
ROOF NOTE:NO FINAL INSP,SHALL MADE BEFORE SOFT ELOOH AREA TOTALACREAGE
DIAPHRAGM
THE CONSTRUCTION TAX IS PAID
NuILDI USE
ROOF SHEATHING RES IND CON PR ole..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.p ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL - MECH.ENERGY
ELECTRICAL BUILDING ENERGY ADS GATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG SITE NO.
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T]4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
C
A L 4
EXTERIOR'SHEAR - ELECTRICAL RELEASE FLOOD ZONE.
INTERIOR SHEAR FIRE DEPT. Y F-1N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EX TE RI OR.LATH BUILDING
INTERIOR LATH
TEMPORARY AP ROYALS BUILDING lv
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM —
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
o.� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
z
— SEE'PERMIT FOR EXPIRATION DATE — - MECHANICAL
IMPORTANT! ;. CONST.TAX
PLEASE READ REVERSE SIDE BEFOREw"i,
CALLINGTOTAL
FOR FINAL INSPECTION. O�
OFFICE COPY